Provider Demographics
NPI:1841833159
Name:FYFFE-SIMPSON, SHANTAE ALICIA
Entity type:Individual
Prefix:MRS
First Name:SHANTAE
Middle Name:ALICIA
Last Name:FYFFE-SIMPSON
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:SHANTAE
Other - Middle Name:ALICIA
Other - Last Name:FYFFE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:101 HEAD OF MEADOW RD
Mailing Address - Street 2:
Mailing Address - City:NEWTOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06470-1788
Mailing Address - Country:US
Mailing Address - Phone:917-543-4521
Mailing Address - Fax:
Practice Address - Street 1:101 HEAD OF MEADOW RD
Practice Address - Street 2:
Practice Address - City:NEWTOWN
Practice Address - State:CT
Practice Address - Zip Code:06470-1788
Practice Address - Country:US
Practice Address - Phone:917-543-4521
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-21
Last Update Date:2024-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT6889104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker